Bridging: Perioperatives Vorgehen bei dauerhafter oraler Antikoagulation oder Plättchenfunktionshemmung
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Bridging: Perioperatives Vorgehen bei dauerhafter oraler Antikoagulation oder Plättchenfunktionshemmung. / Nowak-Göttl, U; Langer, F; Limperger, V; Mesters, R; Trappe, R U.
in: DEUT MED WOCHENSCHR, Jahrgang 139, Nr. 24, 2014, S. 1301-6.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Bridging: Perioperatives Vorgehen bei dauerhafter oraler Antikoagulation oder Plättchenfunktionshemmung
AU - Nowak-Göttl, U
AU - Langer, F
AU - Limperger, V
AU - Mesters, R
AU - Trappe, R U
N1 - © Georg Thieme Verlag KG Stuttgart · New York.
PY - 2014
Y1 - 2014
N2 - Oral anticoagulants [Vitamin-K-Antagonists, Dabigatran, Rivaroxaban, Apixaban] or antiplatelet agents [Aspirin, Clopidogrel, Prasugrel, Ticagrelor] are effective in preventing thromboembolic diseases. In case of interventional of surgical procedures patients with indications for chronic anticoagulation [atrial fibrillation, valve prosthesis, venous thromboembolism] or use of antiplatelet agents [cerebrovascular events, cardiovascular events] will require interruption of antithrombotic/antiplatelet therapy with the need of replacement with a short-acting agent. Due to limited data available from randomized studies and meta-analyses the evidence level is low in the majority of recommendations. Therefore for each patient the bleeding and thrombosis risk depending on the individual patient constitution and the planned intervention must be weighted. In patients with an intermediate risk for thrombosis the bleeding risk of the scheduled intervention will influence the bridging recommendation: In patients with a low bleeding risk oral anticoagulation/antiplatelet therapy can be continued or reduced in intensity. In patients with an intermediate or high bleeding risk along with a low thrombosis risk a temporary interruption of the anticoagulation/antiplatelet therapy is feasible. In patients with a high thrombosis and bleeding risk anticoagulation should be bridged with unfractionated heparin [renal insufficiency] or low molecular weight heparin. In the latter risk situation, inhibition of platelet function can be achieved with short-lasting GPIIb-IIIa inhibitors [Eptifibatide, Tirofiban]. Prior to intervention patients treated with the new oral anticoagulants [Dabigatran; Rivaroxaban; Apixaban] are requested to temporary interrupt the anticoagulation depending on the individual drug half-life and their renal function. Bridging therapy with heparin prior to intervention is not necessary with the new oral anticoagulants.
AB - Oral anticoagulants [Vitamin-K-Antagonists, Dabigatran, Rivaroxaban, Apixaban] or antiplatelet agents [Aspirin, Clopidogrel, Prasugrel, Ticagrelor] are effective in preventing thromboembolic diseases. In case of interventional of surgical procedures patients with indications for chronic anticoagulation [atrial fibrillation, valve prosthesis, venous thromboembolism] or use of antiplatelet agents [cerebrovascular events, cardiovascular events] will require interruption of antithrombotic/antiplatelet therapy with the need of replacement with a short-acting agent. Due to limited data available from randomized studies and meta-analyses the evidence level is low in the majority of recommendations. Therefore for each patient the bleeding and thrombosis risk depending on the individual patient constitution and the planned intervention must be weighted. In patients with an intermediate risk for thrombosis the bleeding risk of the scheduled intervention will influence the bridging recommendation: In patients with a low bleeding risk oral anticoagulation/antiplatelet therapy can be continued or reduced in intensity. In patients with an intermediate or high bleeding risk along with a low thrombosis risk a temporary interruption of the anticoagulation/antiplatelet therapy is feasible. In patients with a high thrombosis and bleeding risk anticoagulation should be bridged with unfractionated heparin [renal insufficiency] or low molecular weight heparin. In the latter risk situation, inhibition of platelet function can be achieved with short-lasting GPIIb-IIIa inhibitors [Eptifibatide, Tirofiban]. Prior to intervention patients treated with the new oral anticoagulants [Dabigatran; Rivaroxaban; Apixaban] are requested to temporary interrupt the anticoagulation depending on the individual drug half-life and their renal function. Bridging therapy with heparin prior to intervention is not necessary with the new oral anticoagulants.
KW - Administration, Oral
KW - Anticoagulants
KW - Drug Substitution
KW - Hemorrhage
KW - Heparin
KW - Heparin, Low-Molecular-Weight
KW - Humans
KW - Metabolic Clearance Rate
KW - Perioperative Care
KW - Platelet Aggregation Inhibitors
KW - Platelet Glycoprotein GPIIb-IIIa Complex
KW - Risk Assessment
KW - Thrombosis
U2 - 10.1055/s-0034-1370110
DO - 10.1055/s-0034-1370110
M3 - SCORING: Zeitschriftenaufsatz
C2 - 24892468
VL - 139
SP - 1301
EP - 1306
JO - DEUT MED WOCHENSCHR
JF - DEUT MED WOCHENSCHR
SN - 0012-0472
IS - 24
ER -